Healthcare Provider Details

I. General information

NPI: 1609040914
Provider Name (Legal Business Name): MICHELLE LYNN HARTNETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BRODIE LN STE 640
SUNSET VALLEY TX
78745-2551
US

IV. Provider business mailing address

PO BOX 306396
NASHVILLE TN
37230-6396
US

V. Phone/Fax

Practice location:
  • Phone: 512-580-3055
  • Fax:
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-921-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1106045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: